Can ultrasound 10 days after obstetric anal sphincter injury predict anal incontinence at long-term follow-up?

INTRODUCTION AND HYPOTHESIS: The objective was to investigate whether endoanal ultrasound (EAUS) performed 10 days after a primary repaired obstetric anal sphincter injury (OASIS) can predict the severity of anal incontinence (AI) in the long term. METHODS: This prospective cohort study included women with a primary repaired 3b-degree tear, 3c-degree tear or fourth-degree tear at Aarhus University Hospital, Denmark, from 1 September 2010 to 31 May 2011. Clinical assessment and EAUS were performed on day 2, day 10, and day 20 after delivery. Functional outcomes were assessed using a questionnaire at the time of all clinical visits and at the long-term follow-up, 7 years after delivery. AI was graded according to the Wexner score and EAUS defects were graded according to the Starck score. RESULTS: Ninety-six out of 99 women consented to participate. Five women had a secondary sphincter repair and were subsequently excluded from follow-up. Fifty-seven women underwent both EAUS 10 days after delivery and answered the long-term follow-up questionnaire. Median follow-up time was 7.7 years (IQR 7.4-7.8). Mean Wexner score was 4.4 ± 4.8 10 days after delivery and 2.5 ± 2.8 at follow-up; thus, the Wexner score improved over time (p = 0.01). Ultrasound sphincter defects were found in 82.6% of the women. Mean Starck score was 3.0 ± 1.8. The risk of AI was 0% (95% CI 0.0-30.8) if the Starck score was 0. No correlation was found between the Starck score and the Wexner score at follow-up. CONCLUSIONS: We found that performing EAUS in the puerperium following OASIS has limited value in predicting long-term AI.

[Christmas article: Please put your pants on - an RCT].

INTRODUCTION: It is common practice after a pelvic exam to ask a woman to put her pants on, before she is given verbal information. We aimed to compare short-term memory in undressed versus dressed women. METHODS: Thirty-six female Ob/Gyn doctors were randomised to receive verbal information while undressed and still in a lithotomy position, or once dressed again. The primary outcome was the proportion of items recalled from a 20-item list. RESULTS: We found no significant difference in recall; 58% in dressed women versus 62% in undressed women (p = 0.26). CONCLUSION: The memory of women is not affected by, whether or not they are dressed. FUNDING: none. TRIAL REGISTRATION: none.

Twin pregnancies treated with emergency or ultrasound-indicated cerclage to prevent preterm births.

Introduction: Multiple gestations are high-risk pregnancies associated with an increased risk of neonatal morbidity and mortality, mainly due to preterm births. Numerous interventions have been attempted in order to delay the time of delivery and subsequently, prevent preterm births in twin gestations. To date, no really effective intervention has been found. Use of cerclage in twin pregnancies has been controversial. Recently, however, small retrospective cohort studies have shown a potentially positive effect with the use of cerclage in twin pregnancies. The aim of this study was to evaluate pregnancies and neonatal outcomes in twin gestations with a short cervix treated with cervical cerclage at a single University Hospital.Methods: This retrospective cohort study included all women - with twin gestation and a short cervix - who had an ultrasound indicated or emergency cervical cerclage at the Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark between January 1999 and May 2017. Cervical cerclage was offered to women before 26 weeks of gestation if: (1) the cervix at ultrasound was ≤20 mm without cervical dilatation (ultrasound-indicated cerclage), or (2) the cervix at ultrasound was ≤20 mm with cervical dilatation (emergency cerclage). Women with history-indicated cerclage placement or multifetal embryo reduction were excluded. A total of 65 women participated in the study.Results: The median gestational age at cerclage placement was 22.6 weeks with a median cervical length of 10 mm (range 0-20 mm). The frequency of preterm delivery before 32 weeks of gestation was 41.5% and 27.7% before 28 weeks. Median pregnancy latency was 77 days (range 4-148) and the median gestational age at delivery was 33.0 weeks. Gestational age at delivery was significantly lower among women with cervical dilatation and visible membranes than among women with a short cervix only (27.7 versus 33.6 weeks, p < .01) and so was the median pregnancy latency (48 versus 81 days, p < .05). Overall, neonatal survival was 91.5%.Conclusion: Cervical cerclage in twin pregnancies may prolong pregnancy even when placed on a very short or dilated cervix. In our study, the procedure was safe and without any serious complications. The overall neonatal survival rate was high.

[Lipschütz ulcus as a differential diagnosis of vulvar ulcus].

Lipschütz ulcus (LU) is a rare and probably underdiagnosed non-venereal disease, which usually presents in young women. It is characterised by an acute onset of influenza-like symptoms with painful, necrotic ulcerations on the vulva or lower vagina, and the aetiology and pathogenesis is unknown. The diagnosis is clinical after exclusion of other causes of vulvar ulcers. LU heals spontaneously within 4-6 weeks, and treatment is mainly symptomatic.